Pharm chapter 38

A

What does the nurse know to be correct concerning the use of mannitol in patients? A. It decreases intracranial pressure B. It increases intraocular pressure C. It causes sodium and potassium retention D. It causes diuresis in several days

C

What intervention will the nurse perform when monitoring a patient receiving triamterene? A. Assess urinary output every other day B. Monitor for side effect of hypoglycemia C. Assess potassium levels D. Monitor for hypernatremia

B

What is the best information for the nurse to provide to the patient who is receiving spironolactone and furosemide (Lasix) therapy? A. Moderate doses of two different diuretics are more effective than a large dose of one B. This combination promotes diuresis but decreases the risk of hypokalemia C. This combination prevents dehydration and hypovolemia D. Using two drugs increases the osmolality of plasma and the glomerular filtration rate

B

What should the nurse do when a patient is taking furosemide? A. Instruct the patient to change positions quickly when getting out of bed B. Assess blood pressure before administration C. Administer the drug at bedtime for maximum effectiveness D. Teach the patient to avoid fruits to prevent hyperkalemia

A

Which assessment indicates to the nurse a therapeutic effect of mannitol has been achieved? A. Decreased intracranial pressure B. Decreased potassium C. Increased urine osmolality D. Decreased serum osmolality

B

Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? A. Sodium level of 140 mEq/L B. Fasting blood glucose level of 140 mg/dL C. Calcium level of 9 mg/dL D. Chloride level of 100 mEq/L

C

Which patient would the nurse need to assess first if the patient is receiving mannitol? A. A 67-year-old patient with type 1 diabetes mellitus B. A 21-year-old patient with a head injury C. A 47-year-old patient with anuria D. A 55-year-old patient receiving cisplatin to treat ovarian cancer

Diuretics

__________ produce diuresis by inhibiting sodium and water reabsorption from the kidney tubules. These can affect one or more segments of the renal tubules. -Have an antihypertensive effect because they promote sodium and water loss by blocking sodium and chloride reabsorption. This causes a decrease in fluid volume, lowering blood pressure. -With fluid loss, edema should decrease.

Thiazides

___________ act on the distal convoluted renal tubule, beyond the loop of Henle, to promote sodium, chloride, and water excretion. They are not effective for immediate diuresis and should not be used to promote fluid loss in patients with severe renal dysfunction. -They cause a loss of sodium, potassium, and magnesium, but they promote calcium reabsorption. Hypercalcemia may result, and the condition can be hazardous to the patient who is digitalized or has cancer that causes hypercalcemia. -They affect glucose tolerance, so hyperglycemia can also occur.

Osmotic diuretics

___________ increase the osmolality and sodium reabsorption in the proximal tubule and loop of Henle. Sodium, chloride, potassium, and water are excreted. This group of drugs is used to prevent kidney failure, to decrease intracranial pressure, and to decrease intraocular pressure (IOP)

Spironolactone

_____________, an aldosterone antagonist, was the first potassium-sparing diuretic. It blocks the action of aldosterone and inhibits the sodium-potassium pump. -As a result the heart rate is more regular, and the possibility of myocardial fibrosis is decreased.

Carbonic anhydrase inhibitors

________________ are primarily used to decrease IOP in patients with open-angle (chronic) glaucoma. -They can cause fluid and electrolyte imbalance, metabolic acidosis, nausea, vomiting, anorexia, confusion, orthostatic hypotension, and crystalluria. Hemolytic anemia and renal calculi can also occur. These drugs are contraindicated during the first trimester of pregnancy.

Potassium-sparing diuretics

__________________ act primarily in the collecting duct renal tubules and late distal tubule to promote sodium and water excretion and potassium retention. The drugs interfere with the sodium-potassium pump controlled by the mineralocorticoid hormone aldosterone.

Aldosterone

A mineralocorticoid hormone that promotes sodium retention and potassium excretion

C

A nurse is caring for a patient receiving acetazolamide. Which assessment finding will require immediate nursing intervention? A. A decrease in bicarbonate level B. An increase in urinary output C. A decrease in arterial pH D. An increase in Pa02

B

A patient has heart failure, and a high dose of furosemide is ordered. What suggests a favorable response to furosemide? A. A decrease in level of consciousness occurs, and the patient sleeps more B. Respiratory rate decreases from 28/min to 20/min, and the depth increases. C. Increased congestion is heard in breath sounds, and the patient complains of shortness of breath D. Urine output is 50 mL/4 h, and intake is 200 mL.

A, B, C, D

A patient is ordered furosemide to be given via intravenous push. Which interventions will the nurse perform? Select all that apply. A. Administer at a rate no faster than 20 mg/min B. Assess lung sounds before and after administration C. Assess blood pressure before and after administration D. Maintain accurate intake and output record E. Monitor the electrocardiogram continuously F. Insert an arterial line for continuous blood pressure monitoring

D

A patient is prescribed chlorthalidone. What is the most important information the nurse will teach the patient? A. "Do not drink more than 10 ounces of fluid a day while on this medication." B. "Take this medication on an empty stomach." C. "Take this medication before bed each night." D. "Wear protective clothing and sunscreen while taking this medication."

B

A patient is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance? A. Hypocalcermia B. Hypokalemia C. Hyperkalemia D. Hypermagnesemia

C

A patient taking spironolactone has been taught about the medication. What menu selection indicates that the patient understand teaching related to this medication? A. Potatoes B. Lima beans C. Chicken D. Strawberries

C

A patient with acute pulmonary edema is receiving furosemide. What assessment finding indicates to the nurse that the intervention is working? A. Potassium level decreased from 4.5-3.5 mEq/L B. Improvement in mental status C. Lungs clear to auscultation D. Output 30 mL/h

Decrease hypertension and decrease edema

Diuretics are used for 2 main purposes:

Natriuresis

Diuretics that act on the tubules closest to the glomeruli have the greatest effect in causing ___________.

B

For the patient taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose? A. To decrease serum potassium level B. To increase serum potassium level C. To decrease glucose level D. To increase glucose level

Loop diuretics

The ________________ act on the thick ascending loop of Henle to inhibit chloride transport of sodium into the circulation and inhibit passive reabsorption of sodium. Sodium and water are lost, together with potassium, calcium, and magnesium. -They can affect blood sugar and increase uric acid levels

C

The nurse is assessing a patient who is taking furosemide. The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? A. Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly B. Administer sodium polystyrene sulfonate C. Administer 2 mEq potassium chloride per kilogram per day IV D. Administer calcium acetate, two tablets three times per day

B, C, D, E

The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide? (Select all that apply.) A. Monitor patients for signs of hypoglycemia B. Administer ordered potassium supplements C. Monitor serum potassium and uric acid levels D. Assess blood pressure before adminstration E. Notify the health care provider if a patient has had oliguria for 24 hours F. Assess for decreased cholesterol and triglyceride levels

B

The nurse notes that the patient is receiving hydrochlorothiazide for hypertension. Which additional medication in the patient's drug regimen would cause concern on the part of the nurse? A. Maalox B. Digoxin C. Nitroglycerine D. Albuterol

B

The patient has been receiving spironolactone 50 mg/day for heart failure. The nurse should closely monitor the patient for which condition? A. Hypokalemia B. Hyperkalemia C. Hypoglycemia D. Hypermagnesemia